The most renowned European IVF centers closely cooperate with university clinics and scientific institutes. The direct access to the latest scientific investigations in reproductive medicine allows the European reproductive specialists to steadily increase the number of healthy IVF pregnancies and to sophisticate the existing techniques. Technologically advanced IVF laboratories, the latest reproductive tools as well as strict hygiene requirements contribute to higher pregnancy rate and attract an increasing number of patients from the USA, Canada, Great Britain and Saudi Arabia.
The “fertilization in a glass tube” is a comparatively old method, which has been around since the 1970s. About 200 000 US couples participated in the first wide-ranging IVF experiment in 1970-1973, but only the luckiest couples succeeded to get an IVF child. The girl named Louise Brown was born in 1974 with help of in vitro fertilization and now she is a healthy mother of two children. The Australian fertilization specialist, who is responsible for this success, got a Nobel Prize for his contribution to reproductive medicine. The refinement of the fertilization technique took place in the 80s and 90s of the 20th century in Germany and other European countries to achieve the astonishing results at the beginning of the 21st century. The WHO reports that about two million of IVF children were born since 1980. Due to the technological breakthroughs this number is going to double in the next decade.
Indications for IVF
Nowadays the IVF method is advised in case of
- sperm problems (30% of all infertility cases)
- ovulation disorders (20%)
- obstructed fallopian tubes (30%)
- unexplained (idiopathic) infertility (10%).
The German specialists speak about indications for assisted reproductive techniques (fertilization) in those types of infertility, which cannot be managed with hormone medication, minimally invasive (laparoscopic/ endoscopic) therapies or surgical interventions.
The following tests are usually performed before IVF:
- testing ovarian reserve (a key test for a female patient)
- semen analysis
- estimated level of FSН and AMН as well as their correlation (this test is performed on the first days of the cycle)
- fallopian tubes screening
- blood hormones test
Before IVF, you get a face-to-face consultation with the fertility expert, who determines the indications for a certain reproductive method. In many cases phone or Skype consultation with a reproductive specialist is enough to decide, if you are an IVF candidate.
On coming to Germany for IVF tests and treatment you should plan your stay in advance. Many patients take a two-week vacation and combine tests, stimulation and embryo transfer with sightseeing and shopping, which helps to reduce stress and improve the inner balance. It would be reasonable to bring along your medical documentation, records and tests (in English or in German) in order to skip the unnecessary diagnosing steps and to accelerate the treatment process. Nevertheless in some cases it is really recommended to repeat the medical investigations in order to obtain more precise results.
The process of IVF (In Vitro Fertilization)
In vitro fertilization (IVF), colloquially called "artificial insemination", comprises many different individual steps. In addition to hormonal stimulation, this also includes small surgical interventions.
With IVF, fertilization does not take place in the woman's body, but "artificially" in the laboratory. The treatment often lasts for several weeks.
With IVF, hormone treatment for women is almost always necessary. The doctor then takes egg cells from the ovary and combines them with the partner's sperm cells in a laboratory glass. If fertilization is successful and the fertilized egg cells continue to develop, one to max. three embryos are transferred to the uterus.
In-vitro fertilization or ICSI usually starts with hormone preparations (GnRH agonists or GnRH antagonists) which suppress the woman's own hormone release and thus prevent uncontrolled ovulation.
Depending on the treatment regimen, targeted hormonal stimulation of the ovaries begins up to 14 days later. It is supposed to stimulate the ovaries to let several egg cells mature at the same time. This increases the chances of obtaining several fertilizable egg cells.
Different hormone preparations can be used individually or in different combinations for hormone stimulation. They are injected or taken as a tablet. In most cases, a preparation containing the hormone FSH (follicle-stimulating hormone) is injected prior to in vitro fertilization or ICSI. As the ovaries can be overstimulated in rare cases, treatment must be monitored by a doctor.
In some cases, hormonal stimulation of the ovaries is not required. In vitro fertilization then takes place in the woman's natural menstrual cycle (Natural Cycle IVF).
Natural cycle IVF is an artificial insemination that is carried out without prior hormonal stimulation of the female ovaries. For this purpose, an egg cell matured in the natural cycle of the woman is obtained by puncture and then fertilized in the laboratory with the sperm cells of the man. With this method, it is important to remove the mature egg at the exact time just before ovulation. A Natural Cycle IVF can only be used by women who have a reasonably regular cycle with ovulation.
Ovulation is started
Around a week after the start of hormone stimulation, the doctor checks the size and maturity of the developing egg cells several times. To do this, ultrasound examinations are done and hormone levels in the blood are determined. When the eggs have matured and appear to be capable of fertilization, woman stops taking hormones. With an injection of the hormone HCG (human chorionic gonadotropin) or a GnRH agonist, ovulation is started - about nine to eleven days after the start of the stimulation.
Removal of the egg cell
About 36 hours after initiation of the injection, the doctor uses a special needle to remove eggs from the matured egg vesicles (follicle puncture). The procedure is usually carried out via the vagina and followed by ultrasound on the screen. In rare cases, the eggs are obtained by abdominal mirroring. The woman receives sedatives or pain relievers and a short general anesthetic if necessary. After the puncture, slight bleeding and a feeling of sore may occur.
Fertilization in the laboratory
On the day of the egg retrieval, fresh or frozen (cryopreserved) sperm from the partner is required. The man masturbates in a special room of the reproductive medicine center. Some men have difficulties with “on order” ejaculation. You can discuss the problem with your doctor to find another solution. For example, the man can get his semen at home and bring it to the center in a special container, in the case if it takes not much time.
In the case of a severe male fertility disorder, a testicular biopsy and then frozen (cryopreserved) sperm can be thawed in time.
Before the semen and egg can be brought together, the semen is processed in the laboratory. The aim is to improve the fertilization capacity of the sperm cells and to prevent possible allergic reactions in women. Then a specialist brings together egg cells and sperm cells in a nutrient liquid and puts them in an incubator. This is where the egg cells are fertilized - for in vitro fertilization.
The fact that a sperm has penetrated the egg can be recognized under the microscope by the two “pre-nuclei” that contain the genetic material of the sperm and the egg. At this pre-nucleus stage, the eggs are selected that are later to be transferred to the uterus. The other eggs are either destroyed or frozen. This means that they can be used for a possible further treatment attempt without necessity to remove egg cells again.
The transfer of embryos to the uterus
When one or more egg cells have been successfully fertilized, they are placed in an incubator, where they continue to develop. Between the second to maximum sixth day after egg retrieval, the doctor then transfers one three of the embryos that have formed into the uterus. This is done using a thin, flexible tube (catheter) through the vagina. Most women find the procedure to be little or not painful.
"Hatching aid": Assisted hatching
In special cases, for example after three unsuccessful embryo transfers or when frozen (cryopreserved) egg cells are defrosted at the pre-nucleus stage, the conditions for the survival of the transferred embryos can be improved. For this purpose, the outer shell of the embryo is scratched with a laser device (assisted hatching). However, a clear improvement in the chances of success using this method has not been demonstrated.
About 14 days after the embryo or embryos have been transferred to the uterus, the pregnancy hormone HCG in the blood can be used to determine whether pregnancy has started. To make sure, the doctor will do several check-ups. About a month after the transfer, an ultrasound examination can then be used to determine whether the embryo is alive and whether it is a single or multiple.
IVF procedure in Germany: day by day
Within the IVF protocol a woman’s egg is fertilized in a glass tube and then introduced into the uterus with the aim of pregnancy. The traditional IVF includes the following basic steps:
- The stimulation of multiple follicles (induction of superovulation)
- Follicle puncture and extracting the egg cells (oocytes)
- Fertilization in a glass tube
- Embryo selection and cultivation
- Genetic screening (to avoid genetic diseases in a future child)
- Transfer of the multicellular formation (embryo)
- Support of luteal phase after transfer
With the development of at least 3 follicles and endometrial thickness of 8.2 – 11.2 mm, the hormonal stimulation is carried out in order to trigger hCG level. Within 36-38 hours after the administration of hCG the transvaginal follicle puncture under intravenous sedation is done. The extracted eggs are further fertilized with the sperm of a partner at the IVF laboratory.
The embryo development is visualized with a special camcorder, placed into the incubators. After two days the most vital embryos are selected under microscopic control. They are cultivated up to the blastocyst stage, i.e. 4-5 days. The expert teams work closely together and treat each embryo individually as a small patient, as your future child.
Embryo transfer procedure is performed under the computer navigation control on the 5th or 6th day. The transfer of the embryo is almost painless. In some cases light sedation is needed in order to avoid stress and achieve the necessary relaxation. The remaining high-quality embryos after transfer can be frozen, which means that you can avoid the hormonal stimulation, if you come up with the idea to have the next child at this clinic.
As an international patient you are especially privileged. You are consulted and examined by the chief physician and get individualized medical care.
Are there any risks?
Many couples worry about the consequences of fertility treatment for a future baby. Could IVF cause deformities or mental diseases? According to the current state of scientific knowledge, the children born from IVF or ICSI are as healthy as those, conceived in a natural cycle.
A certain risk is associated with hormone stimulation of ovaries. The main reason for overstimulation occurrence is the introduction of excessive amount of medication. Due to high level of expertise, scientific advance and soft medication the risk of ovarian overstimulation is minimized at German fertility clinics.
German fertility centers promote the newest approaches and make use of the complementary and alternative methods of the Eastern medicine (methods of Ayurveda, herbal medicine, acupuncture, relaxation techniques etc.) to support the body and soul of a patient. The latest studies have shown that synergetic combination of different medical traditions contributes to higher IVF pregnancy rates and helps to give birth to healthier children.
How much IVF cost?
The price is formed with the view to a variety of factors, such as the diagnosis, age, personal indications etc. The cost of a total IVF cycle incl. the medications is approximately € 6,200-7 000€ (medications and anesthesia/sedation amounts to 3,800 €). In some cases the public health insurance overtakes 50% of IVF expenditures for the first of three cycles. It refers to the EU citizens. To get an estimated cost for further IVF treatment, please call us or fill in the contact form on our website.
What to do after IVF?
After the protocol you should plan at least two days stay at the hotel not far from the clinic, so that the specialist could monitor your condition. Try to relax, avoid any stress and think positive, since your mental condition may affect the health of your future child. It is a myth that no plane trips should be performed after the IVF. Nevertheless you shouldn’t carry heavy luggage and stay seated for a long time. The so called pregnancy marker (human chorionic gonadotropin) could be tested two weeks after the embryo transfer. The clinical pregnancy is determined with ultrasonography control on the 30-35th day after the IVF.
How initiate your life changing journey to Germany?
According to the GMG survey, about 85% of all international couples, applying for IVF help at German, Austrian or Swiss fertility centers, to fulfill their dream tohave a baby.
German Medical Group is motivated to make your medical trip to Germany as simple, successful and stress-free as possible. Our aim is to achieve the best possible outcome for every couple with infertility diagnosis. Being a health services provider with more than 10 years of experience, we will
- answer every question you have
- consult you in finding the best specialist and clinic in Europe
- provide information on treatment costs (you always get estimate cost from the clinic)
- assist you in getting a medical visa (if you need one)
- arrange your stay at the hotel
- meet you at the airport
- accompany you to the clinic
- take care of your leisure time
- act as a helpful go-between, facilitating your efficient IVF treatment
We want you to focus on treatment and not on organizational problems! For more information, please, call us and get a free expert consultation in English: +49 (7221) 39-65-785.
IVF-statistic in Austria
The conditions for an IVF procedure in Austria are regulated by the Law on Medical Fertilization, which was passed in 2004.
According to the norms of legislation, in Austria it is allowed to carry out IVF only if there are certain medical indications, if all modern and proven therapeutic and surgical methods of treating infertility have not brought the desired result, or their inefficiency is obvious. IVF can also be performed in cases where sexual intercourse is contraindicated for a long period of time due to the risk of transmitting a serious infectious disease to a partner or spouse. This suggests that in Austria IVF can also be carried out in cases where one of the partners suffers from diseases such as AIDS and the hepatitis B. An additional indication for IVF in Austria is the development of reproductive dysfunction due to severe diseases of the body or their treatment.
In Austria, the IVF procedure is mainly performed in case of painful changes and functional abnormalities of the woman’s fallopian tubes (in 65% of all cases), idiopathic nefertility, also called unexplained infertility or infertility of unknown origin (10%), with pathological changes in sperm or male sterility (in 15 % of cases).
The dedicated work of medical specialists, implementation of the latest generation technologies, observance of all quality standards and high success results - all this played a significant role in strengthening of Austrian IVF centers as the leading and most authoritative reproductive health clinics all over the world!
It is explained by the fact that special attention is paid to the selection of the most viable embryos. On average, the chance of successful treatment of infertility is equated by Austrian specialists to 50%. Of course, everything is very individual and the treatment depends on the characteristics of body. Due to the high quality standards, the treatment of infertility in Austria is more effective than in many other EU countries.